Chronic Bronchitis Nursing Care Plan & Management

Notes

Description

Is an inflammation of the lower airways characterized by excessive secretion of mucus, hypertrophy of mucous glands, and recurring infection, progressing to narrowing and obstruction of airflow.

Causes/ Risk Factors

The primary cause of chronic bronchitis is smoking or exposure to some type of respiratory irritant. Established risk factors include a history of smoking, occupational exposures, air pollution,reduced lung function, and heredity. Children of parents who smoke are at higher risk for pulmonary infections that may lead to bronchitis.

Pathophysiology

Assessment

Signs and symptoms of chronic bronchitis (insidious onset):

Productive cough lasting at least 3 months during a year for 2 successive years.

Encourage use of portable oxygen system for ambulation for patients with hypoxemia and marked disability.

Encourage the patient in energy conservation techniques.

Documentation Guidelines

Respiratory status of the patient: Respiratory rate, breath sounds, use of oxygen, color of nail beds and lips; note any respiratory distress

Response to activity: Degree of shortness of breath with any exertion,degree of fatigue

Comfort, body temperature

Response to medications, oxygen,and breathing treatments

Need for assistance with activities of daily living

Response to diet and increased caloric intake, daily weights

Discharge and Home Healthcare Guidelines

Medications. Be sure that the patient understands all medications, including the dosage, route, action, and adverse effects. Patients on aminophylline should have blood levels drawn as ordered by the physician. Before being discharged from the hospital, the patient should demon- strate the proper use of metered-dose inhalers.

Complications. Instruct patients to notify their primary healthcare provider of any change in the color or consistency of their secretions. Green-colored secretions may indicate the pres- ence of a respiratory infection. Patients should also report consistent, prolonged periods of dyspnea that are unrelieved by medications.

Follow-up. Consider that patients with severe disease may need assistance with activities of daily living after discharge. Note any referrals to social services. Send patients home with a diet, provided by the dietitian and reinforced by the nurse, which provides a high-caloric intake. Encourage the patient to cover the face with a scarf if he or she goes out-of-doors in the winter. If the patient continues to smoke,provide the name of a smoking cessation program or a support group. Encourage the patient to avoid irritants in the air.

Exam

MSN Exam for Bronchitis Acute & Chronic (PM)

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Question 1

Nurse Eve formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen demands. Such conditions include:

A

eating more than three large meals a day.

B

drinking more than 1,500 ml of fluid daily.

C

being overweight.

D

eating a high-protein snack at bedtime.

Question 1 Explanation:

Conditions that increase oxygen demands include obesity, smoking, exposure to temperature extremes, and stress. A client with chronic bronchitis should drink at least 2,000 ml of fluid daily to thin mucus secretions; restricting fluid intake may be harmful. The nurse should encourage the client to eat a high-protein snack at bedtime because protein digestion produces an amino acid with sedating effects that may ease the insomnia associated with chronic bronchitis. Eating more than three large meals a day may cause fullness, making breathing uncomfortable and difficult; however, it doesn’t increase oxygen demands. To help maintain adequate nutritional intake, the client with chronic bronchitis should eat small, frequent meals (up to six a day).

Question 2

Which of the following statements are true about acute bronchitis?

A

Acute bronchitis generally follows a viral respiratory infection

B

Smokers and people with heart or lung disease at a higher risk of contracting the disease

C

It affects nose, sinuses, and throat and then spreads to the lungs

D

All of the above

Question 3

Cigarette smoking is the main cause of chronic bronchitis

A

True

B

False

Question 4

Johnny a firefighter was involved in extinguishing a house fire and is being treated to smoke inhalation. He develops severe hypoxia 48 hours after the incident, requiring intubation and mechanical ventilation. He most likely has developed which of the following conditions?

A

Pneumonia

B

Adult respiratory distress syndrome (ARDS)

C

Bronchitis

D

Atelectasis

Question 4 Explanation:

Severe hypoxia after smoke inhalation is typically related to ARDS. The other conditions listed aren’t typically associated with smoke inhalation and severe hypoxia.

Question 5

A 67-year-old client develops acute shortness of breath and progressive hypoxia requiring right femur. The hypoxia was probably caused by which of the following conditions?

A

Atelectasis

B

Asthma attack

C

Bronchitis

D

Fat embolism

Question 5 Explanation:

Long bone fractures are correlated with fat emboli, whichcause shortness of breath and hypoxia. It’s unlikely the client has developed asthma or bronchitis without a previous history. He could develop atelectasis but it typically doesn’t produce progressive hypoxia.

Question 6

Which of the following statements describe cough that is the most common symptom of bronchitis?

A

All of the above

B

Cough can be severe enough at times to injure the chest wall

C

The cough may be dry or may produce phlegm

D

The cough may hang on more than 2 weeks

Question 7

The nurse is caring for an 80-year-old with chronic bronchitis. Upon the morning rounds, the nurse finds an O2 sat of 76%. Which of the following actions should the nurse take first?

A

Notify the physician

B

Recheck the O2 saturation level in 15 minutes

C

Assess the child’s pulse

D

Apply oxygen by mask

Question 7 Explanation:

Remember the ABCs (airway, breathing, circulation) when answering this question. Before notifying the physician or assessing the pulse, oxygen should be applied to increase the oxygen saturation, so answers A and D are incorrect. The normal oxygen saturation for a child is 92%–100%, making answer B incorrect.

Question 8

Continued forceful coughing may cause chest and abdominal muscles to ache.

A

True

B

False

Question 9

A client with acute bronchitis is admitted in the hospital. The nurse assigned to the client is making a plan of care regarding expectoration of thick sputum. Which nursing action is most effective?

A

Splint the patient’s chest with pillows when coughing

B

Offer fluids at regular intervals

C

Place the client in a lateral position every 2 hour

D

Use humified oxygen

Question 9 Explanation:

Fluids liquefy secretions and therefore make it easier to expectorate

Question 10

The term “blue bloater” refers to a male client which of the following conditions?

A

Emphysema

B

Chronic obstructive bronchitis

C

Asthma

D

Adult respiratory distress syndrome (ARDS)

Question 10 Explanation:

Clients with chronic obstructive bronchitis appear bloated; they have large barrel chest and peripheral edema, cyanotic nail beds, and at times, circumoral cyanosis. Clients with ARDS are acutely short of breath and frequently need intubation for mechanical ventilation and large amount of oxygen. Clients with asthma don’t exhibit characteristics of chronic disease, and clients with emphysema appear pink and cachectic.

Question 11

Which is the most common symptom of bronchitis?

A

Wheezing, fatigue, fever and chest discomfort

B

All of the above

C

Cough

D

Shortness of breath worsened by exertion or mild activity

Question 12

The term “pink puffer” refers to the female client with which of the following conditions?

A

Chronic obstructive bronchitis

B

Asthma

C

Adult respiratory distress syndrome (ARDS)

D

Emphysema

Question 12 Explanation:

Because of the large amount of energy it takes to breathe, clients with emphysema are usually cachectic. They’re pink and usually breathe through pursed lips, hence the term “puffer.” Clients with ARDS are usually acutely short of breath. Clients with asthma don’t have any particular characteristics, and clients with chronic obstructive bronchitis are bloated and cyanotic in appearance.

Question 13

A 62-year-old male client was in a motor vehicle accident as an unrestrained driver. He’s now in the emergency department complaining of difficulty of breathing and chest pain. On auscultation of his lung field, no breath sounds are present in the upper lobe. This client may have which of the following conditions?

A

Pneumothorax

B

Bronchitis

C

Pneumonia

D

Tuberculosis (TB)

Question 13 Explanation:

From the trauma the client experienced, it’s unlikely he has bronchitis, pneumonia, or TB; rhonchi with bronchitis, bronchial breath sounds with TB would be heard.

Question 14

What are the additional symptoms of chronic bronchitis?

A

Blue-tinged lips from low levels of oxygen

B

Ankle, feet, and leg swelling

C

All of the above

D

Frequent respiratory infections (such as colds or the flu)

Question 15

A client with shortness of breath has decreased to absent breath sounds on the right side, from the apex to the base. Which of the following conditions would best explain this?

A

Pneumonia

B

Spontaneous pneumothorax

C

Acute asthma

D

Chronic bronchitis

Question 15 Explanation:

A spontaneous pneumothorax occurs when the client’s lung collapses, causing an acute decreased in the amount of functional lung used in oxygenation. The sudden collapse was the cause of his chest pain and shortness of breath. An asthma attack would show wheezing breath sounds, and bronchitis would have rhonchi. Pneumonia would have bronchial breath sounds over the area of consolidation.

Question 16

The nurse in charge formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen demands. Such conditions include:

A

Drinking more than 1,500 ml of fluid daily.

B

Eating more than three large meals a day.

C

Being overweight.

D

Eating a high-protein snack at bedtime.

Question 16 Explanation:

Conditions that increase oxygen demands include obesity, smoking, exposure to temperature extremes, and stress. A client with chronic bronchitis should drink at least 2,000 ml of fluid daily to thin mucus secretions; restricting fluid intake may be harmful. The nurse should encourage the client to eat a high-protein snack at bedtime because protein digestion produces an amino acid with sedating effects that may ease the insomnia associated with chronic bronchitis. Eating more than three large meals a day may cause fullness, making breathing uncomfortable and difficult; however, it doesn’t increase oxygen demands. To help maintain adequate nutritional intake, the client with chronic bronchitis should eat small, frequent meals (up to six a day).

Question 17

Which of the following statements are true about chronic bronchitis?

A

All of the above

B

It requires regular medical treatment

C

Chronic bronchitis is a long-term condition

D

Cigarette smoke, including long-term exposure to second-hand smoke, is the main cause of chronic bronchitis

Question 18

It is unusual to have a dry, nagging cough that lingers for several weeks even after acute bronchitis has cleared.

A

True

B

False

Question 19

What are some of the initial symptoms of bronchitis?

A

Fatigue, fever with chills and chest discomfort

B

Cough that produces mucus

C

Shortness of breath worsened by exertion or mild activity

D

All of the above

Question 20

The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which of the following should the nurse include in the teaching?

A

Use chest breathing.

B

Exhale through an open mouth.

C

Make inhalation longer than exhalation.

D

Use diaphragmatic breathing.

Question 20 Explanation:

In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.

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Nursing Care Plan

Ineffective Airway Clearance

Assessment

Patient may manifest

Wheezes/crackles on auscultation on the BLF

Subcostal retraction

Nasal flaring

Presence of non-productive cough

Increase RR above normal range

Nursing Diagnosis

Ineffective Airway Clearance

Outcomes

Patient will demonstrate effective clearing of secretions.

Patient will maintain effective airway clearance.

Nursing Interventions

Position head midline with flexion on appropriate for age/condition

Rationale: To gain or maintain open airway

Elevate HOB

Rationale: To decrease pressure on the diaphragm and enhancing drainage

Observe S/Sx of infections

Rationale: To identify infectious process

Auscultate breath sounds & assess air mov’t

Rationale: To ascertain status & note progress

Instruct the patient to increase fluid intake

Rationale: To help to liquefy secretions.

Demonstrate effective coughing and deep-breathing techniques.

Rationale: To maximize effort

Keep back dry

Rationale: To prevent further complications

Turn the patient q 2 hours

Rationale: To prevent possible aspirations

Demonstrate chest physiotherapy, such as bronchial tapping when in cough, proper postural drainage.

Rationale: These techniques will prevent possible aspirations and prevent any untoward complications

Administer bronchodilators if prescribed.

Rationale: More aggressive measures to maintain airway patency.

Ineffective Breathing Pattern

Assessment

Patient may manifest

Wheezes/crackles on auscultation on the BLF

Subcostal retraction

Nasal flaring

Presence of non-productive cough

Increase RR above normal range

Nursing Diagnosis

Ineffective Breathing Pattern RT Retained Secretions

Outcomes

Patient will improve breathing pattern.

Patient will maintain a respiratory rate within normal limits.

Nursing Interventions

Place patient in semi-fowlers position

Rationale: To have a maximum lung expansion

Increase fluid intake as applicable

Rationale: To liquefy secretions

Keep patient back dry

Rationale: To avoid stasis of secretions and avoid further complication

Change position every 2 hours

Rationale: To facilitate secretion mov’t and drainage

Perform CPT

Rationale: To loosen secretion

Place a pillow when the client is sleeping

Rationale: To provide adequate lung expansion while sleeping.

Instruct how to splint the chest wall with a pillow for comfort during coughing and elevation of head over body as appropriate

Rationale: To promote physiological ease of maximal inspiration

Maintain a patent airway, suctioning of secretions may be done as ordered

Rationale: To remove secretions that obstructs the airway

Provide respiratory support. Oxygen inhalation is provided per doctor’s order

Rationale: To aid in relieving patient from dyspnea

Administer prescribed cough suppressants and analgesics and be cautious, however, because opioids may depress respirations more than desired.

Rationale: To promote deeper respirations and cough

Impaired Gas Exchange

Assessment

Patient may manifest

Appearance of bluish extremities when in cough (cyanosis), lips

Lethargy

Restlessness

Hypercapnea

Hypoxemia

Abnormal rate, rhythm, depth of breathing

Diaphoresis

Nursing Diagnosis

Impaired Gas Exchange RT Altered Oxygen Balance

Outcomes

Patient will improve ventilation and adequate oxygenation of tissues

Patient will minimize or totally be free of symptoms of respiratory distress.

Nursing Interventions

Monitor level of consciousness or mental status

Rationale: Restlessness,anxiety, confusion, somnolence are common manifestation of hypoxia and hypoxemia.

Assist the client into the High-Fowlers position

Rationale: The upright position allows full lung excursion and enhances air exchange

Increase patient’s fluid intake

Rationale: To help liquefy secretions

Encourage expectoration

Rationale: To eliminate thick, tenacious, copious secretions which contribute for the impairment of gas exchange.